Knowledge is a valuable resource for the growth of individuals and organizations. It represents a cognitive framework that makes possible the meaning and understanding of raw data and information [1
] and sometimes leads to wisdom [2
]. Scientists distinguish two types of knowledge, explicit and implicit [3
]. Explicit knowledge can be expressed through words, numbers, or figures and represents the tip of an iceberg. Most of our knowledge is tacit, and it is hard to formulate and share. It is what Michael Polanyi [6
] said: “We can know more than we can tell”.
The cornerstone of knowledge creation and transfer theory was introduced by Nonaka and Takeuchi [5
] with the SECI model. Since knowledge increases with interaction, it can be articulated and amplified in various entities where individuals cooperate, like businesses and other organizations, making them sustainable [7
]. In the past, scientists insisted on the personal character of knowledge. Next, many agreed that organizational culture exists, especially the heuristic knowledge that is developed by employees while working. Organizational knowledge is achievable when organizations sustain a spirit of cooperation, motivate their personnel, and encourage them to innovate, which means that they have competent management [8
Management embraced knowledge and, around the 1990s, a contemporary business philosophy attracted the interest of executive officers, researchers, and scholars. In this way, the interest in knowledge management (KM) has grown and has been sustained. An increasing amount of digitized information is available because the decision-maker allows an organization to outperform its competitors. The complexity of modern business needs proper information to minimize errors and ensure future success [9
], and the need for quality and best economic outcomes within the business strategy management framework [10
The definition and conceptualization of knowledge management are not easily distinguished [11
] mainly because of the two disjointed approaches that identify KM as technology-centered and people-centered. The first suggests that KM resembles information system management, which uses high technology to make information available and accessible at the right time for the users. The latter focuses on managing knowledge via human resource management practices [12
]. The perspective of this article is human-orientated. Like other scientists, we believe that information and communication systems are tools for effective knowledge management and that attention should be focusing on the human, organizational and cultural aspects of knowledge management [13
]. Healthcare organizations are examples of the balance between humans and engines. Even if the provision of health services relies on modern technologies, health professionals take the final decision for the diagnosis and treatment of the patient.
As Peter Drucker, the renowned professor, stated [14
], “Hospitals are the most complex human organizations ever derived … and the fastest-growing in all developed countries”. Even medium-sized hospitals occupy hundreds of employees from various scientific fields, educational backgrounds, socioeconomic status, and occasionally different cultures. Different groups of employees often have their regulations, perspectives, requirements, and accreditation. Still, they have to interact, cooperate, share information, transform it into knowledge, and perform efficiently to provide high-quality services to the patients and their caregivers. Consequently, it is difficult to share experiences and make comparisons between healthcare settings and other types of organization, and these should be studied independently via their social context and norms.
Healthcare agencies are late adopters of KM philosophy compared to the business sector [15
]. Therefore, healthcare experts have just recently started to show interest in research for evaluating the existence and quality of a knowledge environment in hospitals. In 2015, we conducted a systematic review of knowledge management practices in healthcare settings. We accessed three databases (Medline, Cinahl, and Health Source: nursing/academic edition) for 10 years (1/1/2004-25/11/2014) and retrieved 604 articles, of which 20 articles were eligible for analysis. Most of the studies had a qualitative approach, and researchers collected data through interviews with a small number of individuals or focus groups. Details about preparation, analysis, and results of our systematic review are published [16
]. We confirmed that quantitative research about KM in a healthcare settings is scarce, and there is a lack of an integrated self-administered questionnaire for health professionals who work in healthcare organizations.
Academics and practitioners from other scientific fields have developed appropriate questionnaires for KM [17
]. Still, to our knowledge, no one has until now introduced a reliable quantitative tool that explores KM elements in healthcare organizations.
The purpose of this study is to develop and test a questionnaire to learn more about knowledge management in healthcare settings. We aim to create a tool that could explore attitudes, emotions, cognition, intention or behavior, and identify motivators of and barriers to employees about KM.
This research aimed to develop a questionnaire to understand the concepts of knowledge management and to investigate the organizational factors that affect all aspects of the knowledge creation process within hospitals.
Knowledge management is related to sustainability, organizational learning, knowledge transfer, quality of care and safety, type of motivations, and barriers, all of which will affect the level of service.
4.1. Knowledge Management and Sustainability
The application of knowledge management can lead to a sustainable healthcare system, and leaders can achieve the goals of their organizations [61
]. It is important to note that the knowledge management process can be significantly related to improvements in the quality of healthcare as well as the organizational-level of social and economic outcomes, as stated by Popa [10
]. Doctors may process the information related to the healthcare industry, and based on their experience and knowledge, can improve the quality of the system and the management of their patients. Moreover, patients can increase their knowledge from various sources like the internet, social media, and other medical staff. In this way, patients can determine or change their behavior and thoughts and demand the best possible service. The optimal management of the knowledge process affects the quality of a system.
Social stainability issues in healthcare facilities is another aspect which is explained by [63
]. An organization with collaboration can apply knowledge management to share information to make healthcare organizations sustainable.
4.2. Knowledge Management and Human Resources
Knowledge is also regarded as organizational culture, skills, reputation, intuition, and codified theory that influences human behavior and thoughts [65
]. There is also a concern about the current and future status of human resources management in healthcare organizations [67
] and the impact of human resources information systems technology. Each organization will need to use HR practices that will balance evidence from data, its objectives, individual factors, and Human Resources Information systems. Organizations are becoming increasingly aware of the importance of employees in gaining and maintaining competitive advantage.
The competitiveness of a healthcare organization depends on the effectiveness of its knowledge management [62
], and the knowledge-sharing process helps sustainable engagement in healthcare.
4.3. Knowledge Management and Organisational Learning
With knowledge management, healthcare leaders can understand how collective learning enhances the quality and safety improvement of hospitals. Organizations can support the process of internal learning if the goal is the improvement of their services. External knowledge acquisition often occurs through processes involving people. Knowledge management can help to reduce errors. For example, effective control is achieved using a clinical decision-support system. As a result, the potential reduction of medical errors can affect the improvement of healthcare delivery.
For example, research suggests that collective learning plays a role in improvement [68
]. Specifically, cooperative learning is the process of gaining information which helps the capabilities in groups and organizations. Another process is collective learning, which has to do with the understanding and skills in groups and organizations [68
]. Collective learning differs from individual learning because it requires individuals to analyze and interpret organizational experience [68
The implementation of knowledge management can be thought of in two different ways [70
]. The first is that there is a possibility that knowledge management to increase the autonomy of the medical staff by enhancing knowledge access. Knowledge sharing can lead to knowledge creation. On the other hand, controlling activities of the team can decrease collective intelligence. The excess of autonomy can encourage individuals to destabilize the organization, and there is a chance for them to act against the interests of the organization.
4.4. Knowledge Management and the Developed Questionnaire
Scientific interest in the various aspects of knowledge management can allow the connection of past results and the creation of knowledge. The findings and their implications should be addressed in the broadest context possible. Future research directions may also be highlighted. Perceptions of knowledge management were examined for another group of professionals, such as librarians in India [72
] and other sectors, like construction and design companies in Spain [73
]. Comparisons have been made between the perceptions of employees about knowledge management from small and large organizations in the United Kingdom [74
]. Intrinsic and extrinsic motivations of KM were explored by researchers from various scientific fields [30
]. There is still a debate in this field if external rewards can be considered as drivers for knowledge sharing, and our questionnaire aspires to clarify this issue. Knowledge creation, sharing, and cooperation are amongst the most researched topics in this area. However, in the healthcare sector, the focuses were mainly qualitatively analyzed [16
], even if there are a small number of surveys, e.g., [37
]. As regards leadership, studies have indicated individual styles of leadership to be significantly associated with the art of KM practices [76
]. Zheng et al. [77
] suggest that KM fully mediates the impact of organizational culture, and Leidner et al. [78
] claim that organizational culture influences knowledge management initiatives. Based on these findings, we will subsequently create a model to determine the correlation structure of KM dimensions using a structural equation modeling procedure.
We think that self-efficacy plays an essential role in knowledge sharing. Until now, self-efficacy is mainly correlated with computer skills and knowledge-management systems [79
] and less with occupational self-efficacy. With our dataset, we could check for significant connections between occupational self-efficacy and intentions to create or share knowledge.
The barriers of knowledge management procedure will be studied using the information we have collected with a closed and open-ended question. We asked health professionals to name the three most essential barriers according to their experience about the implementation of knowledge management in their organizations. The rationale of the task is to reveal existing barriers, especially in their working environment, and understand the correlations of barriers with the rest of the dimensions of the set-up questionnaire, e.g., leadership, and organizational culture.
The main advantage for the use of a specific knowledge-management instrument for healthcare units concerning a standard KM questionnaire is that the former takes into account the sui generis nature of the healthcare environment and the particular type of working relationships among health professionals. Additionally, the design of AKMI was done cautiously, with carefully examined methodological steps of an exhaustive literature review, pilot testing and retesting extended discussions with health professionals, and item reduction with factor analysis according to the main findings. The completion time was acceptable, and the dropouts were practically non-existent. Finally, participants spontaneously expressed their content after completed the questionnaire by stating that “this was their first step to actively participating in the knowledge-management process.”
In terms of limitations, there are some caveats about specific dimensions of the questionnaire due to a just fair Cronbach’s alpha score. Furthermore, our study does not permit premature generalization of the results obtained.
In summary, this paper describes the process of development and validation of a questionnaire with nine dimensions of knowledge management in healthcare organizations, perceptions of knowledge management, intrinsic and extrinsic motives, knowledge creation and sharing, cooperation, leadership, culture, and barriers. The introduction with AKMI makes a novel contribution to the study of KM in the area of healthcare organizations, adopting a social orientation at which employees and managers are the protagonists for successful KM in contrast to systems and sophisticated structures. Thus, AKMI has theoretical and practical implications. Universities may use the scale to explore knowledge management as a social process, at which people are the drivers of knowledge, smoothing the transitions from academia to practice. Similarly, it is useful to managers who need to know how they could motivate their personnel to engage in knowledge creation and sharing in an unimpeded way, in a working environment where innovation is supported.
Hospitals, as part of their operations, need to use knowledge-management systems to facilitate their operations’ sustainably. Learning is an essential process, which is related to knowledge management [80
]. The knowledge-creation process can lead to a sustainable competitive advantage process. However, few studies have empirically investigated how individual characteristics and organizational work practices influence knowledge sharing [81
]. The knowledge creation process is vital for sustainability [82
], and social media have an impact on this process [83
]. Knowledge management enablers such as organizational structure, information technology (IT), strategy, and culture can be essential factors for the sustainability process of any healthcare organization. Different categories of healthcare employees have their role within sustainable operations, and human resources managers are encouraged to recruit people with the right qualifications to apply knowledge management.